Ahmad MI, et al. - In this study including 6,323 participants (58.4±13.1 years, 53.9% women, and 49.7% Non-Hispanic whites) without clinical cardiovascular disease (CVD) from NHANES-III, researchers investigated if elevated uric acid (UA) was related to silent myocardial infarction (SMI) or if an increased risk of mortality could be predicted by their joint association. Electrocardiographic evidence of myocardial infarction (MI) without a history of MI defined SMI. Multivariable logistic regression model as well as Cox-proportional hazard analysis were used. Higher odds of baseline SMI were observed in association with higher baseline level of UA. Of 1,916 all-cause death reported during a median follow up of 14 years, CVD deaths were 774. A 29% increased risk of all-cause mortality was seen in participants with highest UA vs those with the lowest UA quartile values and without SMI. The presence of SMI resulted in an increase in this risk by 107%. Similar results were observed for CVD mortality. An increased risk of all-cause and CVD mortality was noted in relation to SMI only in higher quartiles of UA. A strong link between UA with SMI, and the additive impact of UA and SMI on mortality indicate that UA can be a potential marker of poor outcomes.